Interobserver variation in the assessment of pelvic organ prolapse.
Interobserver variation in the assessment of pelvic organ prolapse.
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DOI：
10.1007/bf01894199
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发表时间：
1996-01-01
期刊：
影响因子：
--
通讯作者：
Walters, M D
中科院分区：
文献类型：
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作者：
Kobak, W H;Rosenberger, K;Walters, M D
本研究的目的是确定两种盆腔器官脱垂分级系统的观察者间一致性：阴道轮廓和国际失禁协会（ICS）草案建议。连续49名妇女提到的评价尿失禁和/或盆腔器官脱垂进行了研究。首先由医生和临床护士使用阴道轮廓对患者进行检查，然后根据ICS术语标准化草案（1994）中描述的技术进行检查。使用Kappa统计量和Pearson相关系数确定ICS系统的观察者间变异性，包括总体分期、分期特异性比较和特定解剖位置。通过获得脱垂总体程度的Kappa值、阶段特异性比较和解剖区域来评价阴道轮廓。ICS分期的Kappa值为0.79（P < 0.001），阴道轮廓与最大脱垂面积的Kappa值为0.68（P < 0.001），表明两个系统的观察者间基本一致。ICS系统通过阶段特异性比较发现观察者间存在实质性一致性。ICS分期系统的所有解剖位置均显著相关，观察者间的精确度较高，阴道轮廓在总体脱垂程度、特定脱垂程度和解剖区域方面也显示出显著的观察者间一致性。得出的结论是，无论是建议的ICS分期系统和传统的阴道轮廓显示显着的观察者之间的协议，无论是整体阶段，阶段特定的分析和特定的位置。注册护士考试与医师考试相关性良好，表明获得可重复结果的最重要因素可能是定义和密切关注检查技术。
The aim of this study was to determine the interobserver agreement of two grading systems for pelvic organ prolapse: the vaginal profile and the International Continence Society (ICS) draft proposal. Forty-nine consecutive women referred for evaluation of urinary incontinence and/or pelvic organ prolapse were studied. Patients were first examined by a physician and a nurse clinician using the vaginal profile, followed by an examination according to the technique described in the ICS draft proposal for standardization of terminology (1994). kappa statistic and Pearson's correlation coefficient were used to determine interobserver variability for the ICS system by overall stage, by stage-specific comparison, and by specific anatomic location. The vaginal profile was evaluated by obtaining a kappa for overall degree of prolapse, stage-specific comparison and by anatomic area. The kappa for the ICS stage was 0.79 (P < 0.001), and the kappa for the vaginal profile by area of greatest prolapse was 0.68 (P < 0.001), indicating substantial interobserver agreement for both systems. The ICS system was noted to have substantial interobserver agreement by a stage-specific comparison. All anatomic locations of the ICS staging system were found to correlate significantly, and a high degree of interobserver precision was found. The vaginal profile also showed significant interobserver agreement by overall degree of prolapse, by specific degree of prolapse, and by anatomic area. It was concluded that both the proposed ICS staging system and the traditional vaginal profile show significant interobserver agreement both by overall stage, stage-specific analysis and specific location. The registered nurse examination correlated well with the physician examination, indicating that the most important factor in obtaining reproducible results may be definition and close attention to examination technique.